Avaliação do nível de profilaxia para tromboembolia venosa em uma unidade de terapia intensiva
Carregando...
Arquivos
Data
2018-07-13
Autores
La Terza, Tassiana
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: O Tromboembolismo Venoso (TEV) inclui a trombose venosa profunda (TVP) e a tromboembolia pulmonar (TEP), que são doenças com causa de óbito hospitalar evitável mais comum, principalmente em pacientes críticos sejam eles cirúrgicos ou clínicos. Objetivo: Analisar o nível de profilaxia de TEV em pacientes na Unidade de Terapia Intensiva (UTI) por afecções clínicas e cirúrgicas. Verificar fatores clínicos associados ao desenvolvimento de TEV na UTI e diminuir a escassez de estudos na literatura que avaliem as práticas de profilaxia de TEV em UTI no Brasil. Métodos: estudo transversal observacional de caráter descritivo realizado através de análise de prontuários eletrônicos. Participaram pacientes internados na UTI durante o período de março de 2016 a março de 2017 e tiveram seus riscos de tromboembolismo venoso estratificado segundo a 9ª Diretriz para Profilaxia do TEV do American College of Chest Physicians (ACCP). A adequação da tromboprofilaxia foi determinada de acordo com a concordância entre a conduta instituída e a conduta preconizada nas diretrizes. Resultados: Dos 182 pacientes analisados, 60% foram do sexo feminino. A idade média foi de 61,8 ± 18,0 anos, sendo 77% dos pacientes com idade maior que 50 anos. A idade média dos pacientes cirúrgicos foi significativamente maior em relação aos clínicos e dos pacientes do estudo (p=0,046), assim como tempo de internação hospitalar (p= 0,005) e na UTI (p= 0,010) também foi significativamente maior nos cirúrgicos. A profilaxia farmacológica foi adequada para 68% dos pacientes. Os pacientes cirúrgicos receberam profilaxia farmacológica com maior frequência em relação aos clínicos (76% vs 60%). Em relação à profilaxia geral, os pacientes cirúrgicos receberam menor taxa de profilaxia adequada em relação aos clínicos (15% vs 64%). Apesar disso, a taxa de sangramento decorrente de profilaxia farmacológica foi maior entre os pacientes clínicos em relação aos cirúrgicos (9% vs 3%). Entretanto, os episódios de sangramento foram considerados como menores e não houve nenhum óbito associado ao evento adverso. Conclusão: O uso de anticoagulantes para fins profiláticos e/ou terapêuticos é o fator significante para tempo de internação em UTI. A profilaxia farmacológica do estudo é de 68%, com taxa maior entre os pacientes cirúrgicos em relação aos clínicos (76% vs 60%); O nível de profilaxia farmacológica do estudo mostra a taxa acima da média nacional de 51%, mas ainda aquém do ideal de 100%. A conscientização dos profissionais de saúde, sobretudo de UTI deve ser reforçada para melhor identificação dos pacientes de risco para TEV.
Introduction: Venous Thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) which are diseases with the most common avoidable cause of death especially in critical patients, whether surgical or clinical. Objective: Analyze the level of VTE prophylaxis in patients in the Intensive Care Unit (ICU) due to clinical and surgical conditions. Verify clinical factors associated with the development of VTE in the ICU and reduce the scarcity of studies in the literature that evaluate the practices of VTE prophylaxis in ICUs in Brazil. Methods: an observational cross-sectional study of descriptive character performed through electronic medical records analysis. Patients admitted to the ICU during the period from March 2016 to March 2017 had their risks of venous thromboembolism stratified according to the 9th American College of Chest Physicians (ACCP) Guidelines for VTE Prophylaxis. The adequacy of thromboprophylaxis was determined according to the concordance between the established procedure and the recommended behavior in the guidelines. Results: from the 182 patients analyzed, 60% were female. The mean age was 61.8 ± 18.0 years and 77% of the patients were older than 50 years. The mean age of the surgical patients was significantly higher in comparison with clinicians and the patients of the study (p = 0.046), as well as the length of hospital stay (p = 0.005) and in the ICU (p = 0.010). Pharmacological prophylaxis was adequate for 68% of the patients. Surgical patients received pharmacological prophylaxis more frequently than clinicians (76% vs 60%). Regarding prophylaxis, surgical patients received a lower adequate prophylaxis rate than clinicians (15% vs 64%). Despite this, the bleeding rate due to pharmacological prophylaxis was higher among the clinical patients compared to the surgical ones (9% vs 3%). However, the episodes of bleeding were considered as minor and there were no deaths associated with the adverse event. Conclusion: The use of anticoagulants for prophylactic and/or therapeutic purposes is the significant factor for the length ICU stay. The pharmacological prophylaxis of the study is 68%, with a higher rate among the surgical patients compared to the clinical ones (76% vs 60%); The level of pharmacological prophylaxis in the study shows the rate above the national average of 51%, but still below the ideal of 100%. The awareness of health professionals, especially ICUs, shall be reinforced in order to better identify patients at risk for VTE.
Introduction: Venous Thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) which are diseases with the most common avoidable cause of death especially in critical patients, whether surgical or clinical. Objective: Analyze the level of VTE prophylaxis in patients in the Intensive Care Unit (ICU) due to clinical and surgical conditions. Verify clinical factors associated with the development of VTE in the ICU and reduce the scarcity of studies in the literature that evaluate the practices of VTE prophylaxis in ICUs in Brazil. Methods: an observational cross-sectional study of descriptive character performed through electronic medical records analysis. Patients admitted to the ICU during the period from March 2016 to March 2017 had their risks of venous thromboembolism stratified according to the 9th American College of Chest Physicians (ACCP) Guidelines for VTE Prophylaxis. The adequacy of thromboprophylaxis was determined according to the concordance between the established procedure and the recommended behavior in the guidelines. Results: from the 182 patients analyzed, 60% were female. The mean age was 61.8 ± 18.0 years and 77% of the patients were older than 50 years. The mean age of the surgical patients was significantly higher in comparison with clinicians and the patients of the study (p = 0.046), as well as the length of hospital stay (p = 0.005) and in the ICU (p = 0.010). Pharmacological prophylaxis was adequate for 68% of the patients. Surgical patients received pharmacological prophylaxis more frequently than clinicians (76% vs 60%). Regarding prophylaxis, surgical patients received a lower adequate prophylaxis rate than clinicians (15% vs 64%). Despite this, the bleeding rate due to pharmacological prophylaxis was higher among the clinical patients compared to the surgical ones (9% vs 3%). However, the episodes of bleeding were considered as minor and there were no deaths associated with the adverse event. Conclusion: The use of anticoagulants for prophylactic and/or therapeutic purposes is the significant factor for the length ICU stay. The pharmacological prophylaxis of the study is 68%, with a higher rate among the surgical patients compared to the clinical ones (76% vs 60%); The level of pharmacological prophylaxis in the study shows the rate above the national average of 51%, but still below the ideal of 100%. The awareness of health professionals, especially ICUs, shall be reinforced in order to better identify patients at risk for VTE.
Descrição
Palavras-chave
Tromboembolismo Venoso, Profilaxia, Unidade de Terapia Intensiva, Venous thromboembolism, Prophylaxis, Intensive care unit